About Aesthetic Flat Closure – Surgery – Breastcancer.org

Many people think of reconstructive surgery as breast reconstruction with tissue flaps or implants. But aesthetic flat closure — considered to be the gold standard for going flat — is also a form of reconstructive surgery. 
Aesthetic flat closure (also called post-mastectomy chest wall reconstruction) can be done at the time of mastectomy (immediate) or a few months afterward (delayed). During the procedure, a surgeon removes extra skin, pockets of fat, or excess tissue and tightens and smooths out the remaining tissue to create a flat chest wall contour. Sometimes after immediate flat closure, some people need a second procedure to minimize a scooped-out look or to smooth out any divots or indentations. 
Breast surgeons who perform mastectomies also may be able to perform aesthetic flat closures. Still, it’s not unusual for a breast surgeon to bring in a plastic surgeon to perform the aesthetic flat closure. 
Aesthetic flat closure requires proficiency with certain surgical techniques, such as:
making incisions that avoid bulges of extra skin under the arm (dog ears) and in the chest area (most women prefer two incisions rather than one long incision across the chest, although in some cases one long incision is required; different body types may require different incisions)
using fat grafting or tissue transfer techniques to achieve a smoother contour and avoid a scooped-out look
using local tissue flaps to smooth out uneven areas
knowing how to remove all extra skin and tissue, including in the areas above and below where the breasts were and under the collarbone
It may be best to have a plastic surgeon perform the aesthetic flat closure in the following cases:
when a higher body mass index (BMI) means there is a greater amount of skin and fat to remove
when a larger breast size means there is more breast tissue to remove
when the tumor’s location is at the base of the breast and near the chest, rather than in the outer breast tissue and closer to the nipple 
when radiation therapy before or after breast cancer surgery affects the skin and tissue quality in the area
Thanks to the Women’s Health and Cancer Rights Act of 1998, most health insurance plans cover breast reconstruction with tissue flaps or implants and any other reconstructive procedures needed to achieve balance (symmetry). Still, it’s important to know that there is currently no procedure code specific to flat closure that doctor’s offices can use when submitting paperwork to health insurance companies. So it’s a good idea to call your health insurance company to confirm whether your plan covers aesthetic flat closure.
It’s also a good idea to talk with your breast surgeon or plastic surgeon to make sure they submit claims describing the surgery as reconstructive, rather than cosmetic. You can also ask to speak with the administrator in the practice who handles health insurance claims. It may be helpful to connect with reputable advocacy organizations, such as Not Putting on a Shirt, which outlines some of the issues patients and providers should look out for when it comes to health insurance coverage.
Written by: Kristine Conner, contributing writer
— Last updated on August 2, 2022, 9:04 PM
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